J Emerg Nurs. 2021 Mar;47(2):279-287.e1. doi: 10.1016/j.jen.2020.12.006. Epub 2020 Dec 26.
In March and April 2020 of the coronavirus disease 2019 pandemic, site clinical practice guidelines were implemented for prone positioning of patients with suspected coronavirus disease 2019 in hypoxic respiratory distress who are awake, alert, and spontaneously breathing. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning of patients with coronavirus disease 2019 infection in adult acute respiratory distress or adult respiratory distress syndrome, who are awake, alert, spontaneously breathing, and nonintubated.
A retrospective chart review of patients who were coronavirus disease 2019 positive in the emergency department from March 30, 2020 to April 30, 2020 was conducted for patients with a room air pulse oximetry <90% and a preprone position pulse oximetry ≤94% who tolerated prone positioning for at least 30 minutes. The primary outcome was the change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median and mean differences were compared with the Wilcoxon signed-rank test and paired t-test.
Of the 440 patients with coronavirus disease 2019, 31 met inclusion criteria. Median pulse oximetry increased as 83% (interquartile range, 75%-86%) on room air, 90% (interquartile range, 89%-93%) with supplemental oxygen, and 96% (interquartile range, 94%-98%) with prone positioning (z = -4.48, P < .001). A total of 45% (n = 14) were intubated during their hospital stay, and 26% (n = 8) of the included patients died.
In patients with coronavirus disease 2019 who are awake, alert, and spontaneously breathing, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.
在 2019 年冠状病毒病（COVID-19）大流行的 3 月和 4 月，为了对疑似 COVID-19 缺氧性呼吸窘迫且清醒、警觉、自主呼吸的患者实施俯卧位，现场临床实践指南得以实施。本项大流行灾难实践改进项目旨在测量 COVID-19 感染患者在清醒、警觉、自主呼吸且未插管的情况下，行俯卧位时脉搏血氧饱和度的变化，这些患者患有成人急性呼吸窘迫或成人呼吸窘迫综合征。
对 2020 年 3 月 30 日至 2020 年 4 月 30 日急诊科 COVID-19 阳性患者进行回顾性图表审查，纳入标准为：在接受室内空气脉搏血氧饱和度＜90%和俯卧前位脉搏血氧饱和度≤94%的情况下，能够耐受至少 30 分钟俯卧位的患者。主要结局为患者在接受室内空气、补充氧气以及开始俯卧位治疗约 30 分钟后，与俯卧位相关的脉搏血氧饱和度的变化。使用 Wilcoxon 符号秩检验和配对 t 检验比较中位数和均值差异。
在 440 例 COVID-19 患者中，有 31 例符合纳入标准。在接受室内空气、补充氧气和俯卧位治疗时，脉搏血氧饱和度中位数分别升高至 83%（四分位距，75%～86%）、90%（四分位距，89%～93%）和 96%（四分位距，94%～98%）（z = -4.48，P <.001）。在住院期间，共有 45%（n = 14）的患者接受了气管插管，26%（n = 8）的患者死亡。
在清醒、警觉和自主呼吸的 COVID-19 患者中，初始较低的脉搏血氧饱和度读数在俯卧位后得到改善。未来需要开展研究，以确定俯卧位与随后的气管插管和死亡率之间的关系。
